Perseverance in fragile settings

Author: Robin Schmid/IMA World Health


The Democratic Republic of the Congo (DRC), and its North Kivu province in particular, never seem to catch a break. In the past two years alone, the region has faced two outbreaks of Ebola, the COVID-19 pandemic and the catastrophic eruption of Mount Nyiragongo – all amidst ongoing violent conflict and political instability.

These challenges and their frequency are too often typical of fragile settings. Fragility stems from the devastating consequences of violent conflicts, political instability, public health crises, climate change, and/or economic collapse, among other causes. Such fragile contexts can leave communities caught in a trap of extreme vulnerability and crippling poverty. These are the places where needs are the greatest while operational complexities abound. These are the places where, despite the enormous challenges, IMA World Health perseveres to implement transformative work.


Partnering to prevent and treat disease

In fall 2020, just after the largest Ebola outbreak in DRC history was declared over, we began working with national partners and local health officials to implement a post-Ebola transition and recovery program in North Kivu to restore functional public and private primary health care, laying the groundwork to enhance resilience to future shocks and stresses.

“Our strategy has been mainly teamwork. We used not only each other’s ideas, but also, and most importantly, everyone’s mental strength to support each other to get the job done during tough times.” – Mumbere Lunbo Esaü, project driver

When COVID-19 hit the DRC in 2020, our staff in North Kivu worked with donors, health providers and other workers to locate and distribute personal protective equipment, specialized medical gear and other critical supplies to health facilities. When Ebola struck again in 2021, we supported surveillance efforts for Ebola and other infectious diseases and accompanied local health providers to ensure the continuation of health care to women and children. Through the turmoil, IMA World Health stood by health providers, persevering together through these overwhelming realities.

Community resilience

As if these challenges were not formidable enough, devastation struck the country again on May 22, 2021, when Mount Nyiragongo near the city of Goma erupted, disrupting water supplies and electricity, destroying homes and health infrastructure, creating smoke, ash, and acid rain, and causing thousands to flee the area. Health providers lost their homes, facilities, supplies, and educational and training materials. Government officials called for the city to be evacuated, but for doctors, nurses and other health providers to remain. Unwavering, IMA World Health staff worked alongside local health providers to adapt to this latest shock and addressed immediate health needs of the growing displaced population.

Health workers relied on their deep knowledge of communities and on relationships that had been established through many years of collaboration with IMA World Health on Ebola education and mitigation efforts funded by USAID and other partners.

“We managed to work thanks to good communication with the population. We used home visits, educational talks, mass awareness and good hygiene practices.” – Mbusa Musayi, community health worker

Meeting the expressed needs of the community in a way that engendered local ownership and recognition of health zone authorities helped to create pathways for both learning and resilience.

Now, IMA World Health is working with government officials, national and local organizations, and other partners in 10 Ebola-affected health zones in North Kivu Province to ensure access to and provision of high-quality maternal, newborn, and child health services, voluntary family planning, and reproductive health care. We also help to strengthen routine immunizations, expand access to nutrition and hygiene services, and increase access to care for infectious diseases, including tuberculosis, Ebola, and COVID-19.


Path of persistence

Fragile settings are among the most challenging places to implement critical health programs and advance access to quality medical care. IMA World Health staff and local health workers constantly deal with road closures, lack of electricity, water shortages, loss of internet and telephone connections and many other logistical and operational challenges. Yet IMA World Health will continue to work alongside the Congolese government and an array of local and international partners, as we have since 2000, to strengthen the country’s health system, fight diseases and improve health services. Such long-term investment in the DRC has required resilience, creativity, and an incredible network of staff and partners to navigate successive armed conflicts, political instability, impassable roads and other obstacles that continue to threaten the health and well-being of the population. Together we will persevere to change the narrative and the trajectory of health care in the DRC, no matter the challenge.